A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Pedicle and lateral mass screw placement is technically demanding due to complex 3D spinal anatomy that is not easily visualized. Neurosurgical and orthopedic surgery residents must be properly trained in such procedures, which can be associated with significant complications and associated morbidity. Current training in pedicle and lateral mass screw placement involves didactic teaching and supervised placement in the operating room. The objective of this study was to assess whether teaching residents to place pedicle and lateral mass screws using navigation software, combined with practice using cadaveric specimens and Sawbones models, would improve screw placement accuracy.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This was a single-blinded, prospective, randomized pilot study with 8 junior neurosurgical residents and 2 senior medical students with prior neurosurgery exposure. Both the study group and the level of training-matched control group (each group with 4 level of training-matched residents and 1 senior medical student) were exposed to a standardized didactic education regarding spinal anatomy and screw placement techniques. The study group was exposed to an additional pilot program that included a training session using navigation software combined with cadaveric specimens and accessibility to Sawbones models.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A statistically significant reduction in overall surgical error was observed in the study group compared with the control group (p = 0.04). Analysis by spinal region demonstrated a significant reduction in surgical error in the thoracic and lumbar regions in the study group compared with controls (p = 0.02 and p = 0.04, respectively). The study group also was observed to place screws more optimally in the cervical, thoracic, and lumbar regions (p = 0.02, p = 0.04, and p = 0.04, respectively).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Surgical resident education in pedicle and lateral mass screw placement is a priority for training programs. This study demonstrated that compared with a didactic-only training model, using navigation simulation with cadavers and Sawbones models significantly reduced the number of screw placement errors in a laboratory setting.</jats:p></jats:sec>

Systematic review of the current status of cadaveric simulation for surgical training

“…Compared with no simulation training, cadaveric simulation‐trained learners showed significant improvement in most of the tested skill domains. When comparing behaviour change after training in low‐fidelity simulation‐trained and cadaveric simulation‐trained learners, the results were mixed.…”

“…Fifty‐one studies were included in the review, of which 47 were full‐text original research articles and four were conference posters. The main characteristics of studies, including OCEBM and mean MERSQI scores are shown in Tables S2 – S5 (supporting information).…”

“…Various score‐based methods were also used, including procedure scores, global rating scale (GRS), OSATS (Objective Structured Assessment of Technical Skills in Surgery) and the GOALS (Global Operative Assessment of Laparoscopic Skills) scale. Seven of the 23 studies were RCTs and 16 were cohort studies. Of the seven RCTs, three compared cadaveric simulation with no simulation training, and four compared cadaveric simulation with low‐fidelity simulation.…”

“…Fresh‐frozen cadavers, used in 12 of the studies, have gained popularity due to their versatility. The cadavers are non‐exsanguinated, washed with antiseptic soap, and frozen to −20°C within 1 week of procurement.…”

The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement

“…18,19 Using 10 subjects including residents and medical students, Sundar et al demonstrated a reduction in suboptimal screw placement after a sawbones and cadaver training module. 20–23 Similarly, Harrop et al noted no statistically significant differences in pre- and postdidactic scores and in the OSATS using a Sawbones model for a posterior laminectomy with 8 subjects. 24 However, recent studies of orthopedic simulation programs have been able to demonstrate significantly improved cervical lateral mass and thoracic screw placement.…”